药物治疗甲基苯丙胺所致精神障碍有效性的网状Meta分析

Efficacy of different drugs for patients with methamphetamine-induced psychotic disorders:a network meta-analysis

目的通过网状Meta分析评价药物治疗甲基苯丙胺所致精神障碍的有效性。方法计算机检索PubMed、The Cochrane Library、Web of Science、EMbase、CNKI、CBM、WanFang Data和VIP数据库,搜集药物治疗甲基苯丙胺所致精神障碍的有效性的随机对照试验(RCT),检索时限均为建库至2016年10月。由2位评价员独立筛选文献、提取资料和评价纳入研究的偏倚风险后,采用RevMan 5.3软件、R 3.3.2软件及JAGS 4.2.0软件进行网状Meta分析。结果共纳入16个RCT,包括1 676例患者,涉及9种治疗药物。网状Meta分析结果显示,奥氮平[OR=28.00,95%CI(8.10,110.00)]、利培酮[OR=20.00,95%CI(7.70,58.00)]、喹硫平[OR=30.00,95%CI(6.60,160.00)]、齐拉西酮[OR=28.00,95%CI(3.70,230.00)]、氯丙嗪[OR=29.00,95%CI(5.00,200.00)]、阿立哌唑[OR=13.00,95%CI(1.70,93.00)]、氟哌啶醇[OR=19.00,95%CI(2.10,190.00)]与安慰剂相比均可有效改善患者的精神障碍状态,其中喹硫平效果最佳。奥氮平、利培酮、喹硫平、齐拉西酮、氯丙嗪、阿立哌唑与氟哌啶醇两两比较在治疗甲基苯丙胺所致精神障碍有效性方面,差异均无统计学意义。结论药物治疗甲基苯丙胺所致精神障碍,应首选喹硫平,其次可依次选择齐拉西酮或氯丙嗪、奥氮平、利培酮、阿立哌唑和氟哌啶醇。受纳入研究的数量和质量限制,上述结论仍需开展更多高质量研究予以验证。

Objective To systematically review the efficacy of different drugs for patients with methamphetamine-induced psychotic disorders by network meta-analysis. Methods An electronical search was conducted in PubMed, The Cochrane Library, Web of Science, EMbase, CNKI, CBM, WanFang Data and VIP databases from inception to October 2016 to collect randomized controlled trials （RCTs） about different drugs for methamphetamine-induced psychotic disorders, Two reviewers independently screened literature, extracted data and assessed the risk bias of included studies, and then RevMan 5.3, R 3.3.2 and JAGS 4.2.0 softwares were used to perform network meta-analysis. Results A total of 16 RCTs involving 1 676 patients and 9 kinds of drugs were included. The results of network meta-analysis showed that： compared with the placebo group, olanzapine （OR=28.00, 95%CI 8.10 to 110.00）, risperidone （OR=20.00, 95%CI 7.70 to 58.00）, quetiapine （OR=30.00, 95%CI 6.60 to 160.00）, ziprasidone （OR=28.00, 95%CI 3.70 to 230.00）, chlorpromazine （OR=29.00, 95%CI 5.00 to 200.00）, aripiprazole （OR=13.00, 95%CI 1.70 to 93.00）, haloperidol （OR=19.00, 95%CI 2.10 to 190.00） could significantly improve the psychotic disorders of patients with methamphetamine, respectively, in which quetiapine was the best choice. There were no significant differences between any other pairwise comparisons of these different drugs. Conclusion For the treatment of psychotic disorders caused by methamphetamine, quetiapine should be of a priority choice, follows by ziprasidone, chlorpromazine, olanzapine, risperidone, aripiprazole or haloperidol in a descending priority. Due to limited quality and quantity of the included studies, more high-quality studies are needed to verify above conclusion.